An Interview with Harry Bartelink, MD, PhD, RT

Harry Bartelink

By Ismail Kazem, MD, FASTRO and David Morgan, MB

The following interview of Harry Bartelink, MD, PhD, RT, was conducted on March 11, 2021, by Ismail Kazem, MD, FASTRO and David Morgan, MB.

Ismail Kazem:  I will warm up the discussion and then you can take over in a little bit.  Then we can think upon our engagement with this outstanding scholar.  He has 27 pages of CV, and that is something.

Ismail Kazem:  So, Harry, tell me how did you come to study medicine in Nijmegen although you are an Amsterdammer. 

Harry Bartelink:  No, I'm coming from east of Holland, close to the German border.  I was born in Oldenzaal.  At that time there was a nummerus clausus for studying medicine in the Netherlands.  This means that there was a limited number of students that were admitted per university.  I wanted to study in Groningen but the minister of health said, oh, you are Catholic, so you have to move to Nijmegen.

Ismail Kazem:  Fantastic.  And that is where I saw you the first time I guess after you trained with William Penn.

Harry Bartelink:  Yeah you have seen me there.  When I came you inspired me for choosing radiotherapy.  Also, you will remember Dirk Miete.  I did a part of  my medical training in Arnhem, where I was impressed by Dirk Miete. He was the chair of the radiotherapy department there.  He was extremely good in chairing multidisciplinary oncology meetings.

Ismail Kazem:  Did you graduate from Atheneum, or Gymnasium, or high school? 

Harry Bartelink:  I was from Atheneum. 

Ismail Kazem:  From Nijmegen, you went to Amsterdam and you trained with Klaas Breur.

Harry Bartelink:  Correct. 

Ismail Kazem:  Okay.

Harry Bartelink:  I promised my wife to go only for four years to Amsterdam.  Then I wanted to go back to east part of Holland because it's different from Amsterdam.  We nearly had bought a house in the east part of Holland. But at the end of my training as radiation oncologist I said to Klaas Breur thank you so much for training me.  And he said, oh, I have no vacancy at the moment, but are you sure you want to go back to the east part of Holland?  I said yes.  But then I came across a house on the canal and I saw the Dutch sailing team sailing in front of that new house.  I decided to buy that house and was looking forward to summer sailing with my family after my work.  But I have never found time for it, although I have a sailing boat in front of my house. 

Ismail Kazem:  Tell us a little bit about the set up at Antoni van Leeuwenhoek hospital (Netherlands Cancer Institute, NKI) and the way of training at that time.  I understand that on the staff was Klaas Breur, and Marion Burgers and Anton Tierie.  Anybody else? 

Harry Bartelink:  No. That was a limited group in the beginning there were three residents.  It was small cancer hospital, but it was characterized by an extremely multidisciplinary approach, as it's still nowadays. The fascinating items at the radiotherapy department were the EORTC Hodgkin trials.  We were also one of the few centers worldwide with fast neutrons and I learned a lot from that. It had influenced my career later on because I became convinced that, there was no future for fast neutrons. For example, for rectal cancer or bladder cancer the results were similar to those of conventional irradiation. However, if you increase the neutron dose, you got much more complications.  Also for brain tumors, at lower dose, tumor recurs; if you had the higher dose, then the patient dies from necrosis. 

I became convinced - but I'll come back to that later – that hypoxic sensitizers didn't work because the fast neutrons were of course the easy hypoxic sensitizer.  Later on, I went to Stanford and met Martin Brown.  I remember a discussion with him that I mentioned that we had shown with the fast neutrons experience that hypoxia is not worthwhile to focus on, especially with fractionation, you have reoxygination of the tumor during treatment.
Ismail Kazem:  David, I'm going to ask one more question and then you take over.  Then we can shuffle after that.  Harry, you started as interested in head and neck cancer.  Then you switched to breast cancer.  So tell us a little bit about it.  Was that the influence of Gordon Snow or the influence of Snow on you because you worked with a surgical team?  Tell us a little bit about that.  And, David, you take over. 

Harry Bartelink:  Yes, I was indeed.  Let's say I had good contact with Gordon Snow.  He was an excellent ENT specialist with research interest in head and neck cancer.  Because of him, I became interested in neck node metastasis and especially in predicting radiation sensitivity.  What I tried to do, but that completely failed to be honest, was predicting the radiation response on cytology. 

We took cytology specimens from neck node metastasis.  We measured carefully the regression rate and tried to predict which patients responded well and which patients failed.  At the end I'll say the experimental work failed apart from the fact that we could show that residual disease six weeks after radiotherapy was still an important prognostic indicator for recurrence.  But all the lab work was a failure.  But I finished a thesis on the treatment of neck node metastasis.

In the last part of my specialist training, I went to in Institut Gustave Roussy in Paris.  At that time breast-conserving therapy was not done in Holland.  Actually, people were against it.  But I had fascinating discussions with Pierquin, Calle and  Maurice Tubiana. They showed me their excellent expertise with breast conserving therapy. When I came back to Holland after training.  I said to the surgeon, Joop van Dongen we should change the routine use of radical mastectomy for early breast cancer patients.  We should introduce breast-conserving therapy in Holland.  But he said that the surgeons in Holland will not accept this policy as there are no data from randomized clinical trials. 

So, together with Joop van Dongen, we started an EORTC trial, randomizing breast cancer patients with Stage 1 and Stage 2 between radical mastectomy and breast-conserving therapy. With this trial and by television interviews and articles in lady's journals the surgeons were forced to move to breast-conserving therapy.

An important item at that time what we discovered was that the treating institute was the most important prognostic indicator for breast cancer local recurrence.  I have a slide showing only 4 percent local recurrences in my own institute while 35 percent in one of the other participating centers.  That taught us that we should spend a lot of time on quality assurance. Since then, we spent a lot of time on quality assurance programs within the EORTC Radiotherapy Group.

David Morgan:  Quite right, I assume.

Ismail Kazem:  Good.  David, go ahead. 

David Morgan:  Well, that leads very well to the time that you and I first met, Harry, which must have been in the early 1980s I think. 

Harry Bartelink:  I think so. 

David Morgan:  Through the EORTC Radiotherapy Group.  But I'm wondering if there's a gap in the history here between what Ismail is talking about when he knew you and when you first went on as staff at NKI.  When I met you, the breast conservation trial had already been running.  I think it had stopped recruiting even.  We were talking at that time about the boost trial being initiated I think. 

Harry Bartelink:  Right.  

David Morgan:  Is there something we've missed in between that we should talk about as well, do you think? 

Harry Bartelink:  Oh, yes.  After setting up the breast cancer trial, I was looking for other things. After the experience with fast neutrons, I thought I should widen my experience and go abroad.  I've written to Bob Kallman in Stanford to ask for a position in his group in Stanford. There I was looking around and became interested in combined modality.  I continued the work of Peter Twentyman, who had done a lot of research in looking on interaction of radiation in different drugs.  I found that the combination of radiotherapy and cisplatin was much more effective than the other drugs.

I became therefore interested in cisplatin.  Cisplatin was not only a hypoxic sensitizer, but it worked interestingly on DNA repair mechanism and apoptosis.  I started with a lot of cell tissue culture work with the combination of radiation and cisplatin.  In mice, I copied the clinical scheme of five fractions a week cisplatin plus radiotherapy of one weekly cisplatin dose with five fractions of radiation.  We showed that the daily cisplatin plus radiotherapy was most effective.  Also I looked at normal tissues, such as small bowel.  When I left Stanford and went back to Holland I concluded that the combination of radiotherapy and cisplatin, with daily cisplatin, was the best that should be used. 

Back in Holland, I hired Adrian Begg and Fiona Stewart to continue the laboratory research on the interaction of cisplatin and radiation.  In the clinic, together with Caro Schaake- Koning, we started a clinical phase II trials, which was followed by a phase III trial where we combined radiotherapy plus daily cisplatin or weekly cisplatin for patients with lung cancer.  If you look at the end result, you see that the daily cisplatin was the most effective considering recurrence and survival.  We published this lung trial in the New England Journal of Medicine in 1992. But when we finished the trial, I became not any more interested in the combination of radiotherapy and cisplatin as it was too toxic.  I didn't believe my own results, I thought it was just by accident that this trial was positive, as there were no other trials on this combination at that time. 

I moved to some medical imaging work and breast cancer. But eight years later I was invited by the ASCO to give a short comment on three  positive trials on cervical cancer trials with the combination of radiotherapy and cisplatin, presented for the first time at ASCO. This means that eight years after the presentation of our results, our work was confirmed.  That was a surprise to me.  I was too negative in the beginning and I should have believed in my own results. 

David Morgan:  I don't ever remember you being negative about the combination of chemotherapy and radiotherapy, Harry.  That's interesting.  I mean I honestly think that one of the first things I heard you present was this proposal for lung cancer was combined chemo and radiotherapy.  I think it might have been in Dijon.  I don't know if you remember. 

You're being a bit too modest I think.  I think you are always one of the main driving force in the combination of chemo and radiotherapy.  Your achievements there have been massive, I think, you know. 

Harry Bartelink:  But you see how long it takes.  It takes from let's say 20 years from the laboratory to finally acceptance that the combination is working.  That's a long time. 

David Morgan:  Yeah.

Harry Bartelink:  Okay.  So at that time, you're right, this reminds also what I did.  I attended the ISRO (International Society for Radiation Oncology) meeting organized by Maurice Tubiana and Phil Rubin in Paris, an international meeting.  There I proposed a trial on the combination of radiotherapy and chemotherapy for anal cancer.  It combines radiotherapy plus 5-fluorouracil and mitomycin C in anal cancer patients.  This trial became positive for local control. 

David Morgan:  I never joined the EORTC trial of that.  Because there was a parallel trial, as you know, running in the UK at the time.  In retrospect, how do you think of the difference between mitomycin and cisplatins?  Your preference would still be cisplatin? 

Harry Bartelink:  Absolutely, it's more effective and less toxic I think.  But it's never been tested, as far as I know, for anal cancer.  But I am not up to date with literature on anal cancer anymore.  But in principle as I say, cisplatin, at least what I did in the laboratory was much more effective. 

David Morgan:  In the meanwhile, as well as your work with the EORTC, you must have been hugely busy developing the NKI.  Which I think under your leadership, well, it was very eminent.  But I think it's standing in the world probably rose considerably well while you were there, Harry.  What were your plans or what were your thoughts about that? 

Harry Bartelink:  I think I was rather naïve.  Let's say that. 

David Morgan:  Oh, boy.

Harry Bartelink:  In 1985 I worked for the second time at Stanford.  Then Bob Kallman offered me a job at Stanford, which I was considering.  So why should I not stay in California?  I enjoyed the research work and living in Californie. But then Piet Borst, the director at the time of the NKI, called me and said do you want to become head of the department.  I thought  I'm too young, I don't need that.  Plus, I'm happy with combining research and clinical work.  But at the end I decided to accept the NKI position.

David Morgan:  We almost lost you to the Americans, didn’t we? 

Harry Bartelink:  Indeed

David Morgan:  Well, ASTRO.  I should phrase that differently, shouldn't I? 

Harry Bartelink:  Yeah. 

Ismail Kazem:  Okay.  To piggyback on your topic, David, Harry, I understand after you established yourself at Antoni van Leewenhoekziekenhuis, you had several fellowships - we call it here fellowship - where you go and have different experiences as a visiting or have additional training and exposure.  You went to Britain.  You went to Gustave.  I think, in Britain, you went to Royal Marsden.  Is that correct? 

Harry Bartelink:  No, I only gave some lectures on Royal Marsden. 

Ismail Kazem:  What about Gustave Roussy?  You went there for some stay or fellowship with Tubiana I guess? 

Harry Bartelink:  Yeah.  Well, as I said earlier, I enjoyed very much working there, at that point I was interested in head and neck cancer.  I worked with Francois Eschwege.  But during that period, I traveled to all the other institutes in Paris.  That was like to Institut Curie to meet Calle and also to Bernard Pierquin I forgot the name of his hospital.

David Morgan:  Henri Mondor

Harry Bartelink:  Yeah.  Right.  Thanks.  I had a wonderful time because I had freedom.  I could talk to everybody.  I could see everything.  And there I started my interest in breast cancer, like I explained earlier.

Ismail Kazem:  And then I think you had several visits to the U.S.A.
Harry Bartelink:  I went the first time in 1982, and the second time in 1985 working in the group formed by Bob Kallman.  The good thing was also that after that I could travel around in the United States.  The first time in Stanford, it was great because at that time Kaplan was still alive.  There were weekly meetings with Kaplan.  He chaired a multidisciplinary meeting on Hodgkin's disease.  It was great to observe the developments and to talk to Kaplan and to think about it. 

Also, I went to MD Anderson.  I had a wonderful meeting with Fletcher, a great person.  I had a whole afternoon with Gilbert Fletcher discussing everything, especially on head and neck cancer.

Ismail Kazem:  How could you, and what's your advice to young aspiring radiation oncologists, combine the clinical and the research, especially the lab work? 

Harry Bartelink:  The most important thing to set your priorities.  For combining clinical work and research you should spend a significant period full time in the laboratory.  The second thing is, if you're coming back to the clinic, you should look for a sparring research partner. I had a lot of support from Adrian Begg who was a fulltime researcher in the lab. 

My advice to young people is that if you want to start an academic career, don’t only look for a good lab and a good research group but also, when you come back in the clinic, look for a sparring partner whom you can join your research with.  Together you could submit strong research applications. 

Ismail Kazem:  Well, I guess this is much easier in Europe where research is subsidized.  Here in the States, you have to have a grant.  Unless you have a grant, you're going to be able to waste the clinical time in the lab.  As they call it waste. 

Harry Bartelink:  Today, with the academic radiation and oncology situation in the United States, you should come to Europe and work some time here to build up your career.

Ismail Kazem:  Okay.  Well, one of the remarkable things in your CV is that you had recognition in at least three continents - in Africa, in Europe, and in the United States.  And you have awards there.  You had an award in Cairo, I think, with Marion Burgers. You had several awards in Scandinavia, in France, and in the United States.  What sort of trajectory in your life introduced you to that recognition?  A difficult question, but I only ask difficult questions so that I can have a simple answer. 

Harry Bartelink:  Be myself, what I certainly like is the international community.  Meeting with international people to discuss, and to have dinners together with them. 

David Morgan:  We had many wonderful dinners together, Harry. 

Harry Bartelink:  To be honest, that's something that now during lockdown I'm certainly missing - these international meetings, the international dinners, the international exchange. 

David Morgan:  Perhaps you'd like to elaborate a little bit more, Harry, on the work with EORTC Radiation Oncology Group because you were one at the helmsman of that group for quite a long time.  One of its greatest trials was the boost versus no boost trial.  I think it was your brainwave originally.  Tell us your thinking in setting that up.  I remember some interesting ideas you talked about. 

Harry Bartelink:  The boost-no boost trial followed the  mastectomy versus  breast-conserving therapy trial.  At that time there was a lot of hesitation to treat patients with larger tumors.  We included patients with tumors up to 5 centimeters. We showed that the boost halved the local recurrence rate, especially young patients profit a lot from boost therapy.  I was actually convinced that with higher radiation dose, we could also get better results for young breast cancer patients.  That's the reason why we set up the young boost trial in Holland and in French, to prove that one could safely treat these young breast cancer patients. It is worth to mention that we obtained tumor biopsies for research from these patients.  We do genome analysis for these patients at this moment to see which patients will recur and which patients will not recur.  That work is still ongoing and this has led to another trial.  David will know that I was always heavily against partial breast radiation. 

David Morgan:  We had one or two discussion of this in the past, yes. 

Harry Bartelink:  I didn't trust partial breast radiation especially because after tumorectomy you don't know as radiation oncologist where the tumorbed was located.  In our phase II trial and later in the phase III trial patients with breast cancer are treated first with radiotherapy by partial breast radiation, then six weeks later surgery.  Based upon that trial, we have now twice tumor biopsies, one beforehand and the other six weeks after radiotherapy.  We look into the gene expressions and we look into the immune response in trying to predict which patients would benefit from radiotherapy and which patients we should not treat at all with radiotherapy. 

That part of work together with Marc van de Vijver and PhD students is still ongoing.  That's the major highlight let's say of the last years of my research work on breast cancer. 

Ismail Kazem:  You touched on your experience with the neutron therapy. What do you think about the proton therapy?  What sort of future do you envision for it? 

Harry Bartelink:  That's another topic I had been asked to debate against protons. 

Ismail Kazem:  You see, neutron therapy died a natural death.  What do you think about the future of proton?  Do you think it's long term or short term? 

Harry Bartelink:  If I go back to my expertise in Amsterdam: at that time, I could get sufficient money to have access to protons.  However, in 1994, we were the first in the world with the clinical use of the cone beam CT linear accelerator.  I was convinced that our work with cone beam CT, was a much cheaper solution for precision therapy. So, my focus in research work was: how can I treat better the common patients than only a very selected small group of patients with protons. 

But the difference now of course is that, with protons, the machinery is much smaller and cheaper and better sparinf of normal tissue organs.  But you have to compare it with other possibilities.  Now we have already MRI-linacs also. So there will be a place for protons, which is different from our fast neutrons experience.

Ismail Kazem:  But with I think the combination of immune modulation and immunotherapy combined with maybe different dose/time relationship of radiation treatment, the question would be would high LET be beneficial or low LET radiation be more amenable to actually modulate with immunotherapy.  These are all the questions that I think for some future research to answer.

Harry Bartelink:  Absolutely.  But let's say, to be honest, I believe more in immunomodulation with conventional radiotherapy.

Ismail Kazem:  Yeah, but then you have to have a low dose treatment so that you can release the immunomodulation. 

Harry Bartlink:  Yeah.

Ismail Kazem:  Okay.  Let us go on the lighter side.  What was the most difficult disaster in your career?  How did you manage it, and cope with it, and overcome it?

Ismail Kazem:  Or was that smooth sailing through your 27 pages of CV?

Harry Bartelink:  No.  The most difficult period was, as chair of the department, that we had a waiting list for patients.  This was terrible.  As you know, if you have rectal bleeding, you go to your family doctor.  At your family doctor you will see a sign on the wall: if there is blood loss, you should go immediately to your doctor.  You should be immediately treated.  Okay.  Then you're sent to the hospital.  The doctor says, oh, no problem.  Just wait six weeks or two months and then you will be treated.  That was a very awful period for several years.
But I was to a certain extent very fortunate.  You may know that the minister of healthcare, Els Borst, was at first professor in Amsterdam.  During her professorship in Amsterdam, in her inaugural lecture said that radiotherapy was something like shooting with an elephant on a mouse.  After the meeting I called her and said this is ridiculous, what you have said, you should visit us and   see what we are doing.  She spent a whole day here and came to the radiotherapy department.  At that time, I was extremely proud of the work of myself and Marcel van Herk with the cone beam CT.  She became very impressed with the way, how we worked, and what we did.

I was very fortunate because three months later she became Minister of Health in Holland.  For the first time I had direct access, to the Minister of Health so I could explain to her my problems - which I had done already during, that one day visit.  She became very supportive for us.  At the end she helped radiotherapy community a lot in Holland.  We got a lot of extension and much more personnel.  We got a lot of support from her.  That's helped me a lot, so I was very happy with that.   

David Morgan:  Was it at that time, Harry, that the -- let me just step back.  From the outside, we see Holland as having a very well-coordinated radiation oncology community.  The different departments work together extremely well.  Well, compared with most other countries certainly.  Would that cooperation go back to this time that you're talking about?  Now, was that how it all started or was it something earlier?

Harry Bartelink:  No, It was at that time when it started.

David Morgan:  Yeah.  

Harry Bartelink:  I had an extremely good manager at that time.  He was very helpful in organizing this.  This means that we had to fight together with the insurance companies, but with the support of the Minister of Health. 

David Morgan:  Well, yeah.  So your contribution is more than it appears on your CV, which is academic.  You actually achieved a great deal politically in terms of --

Harry Bartelink:  But it was just by accident.

David Morgan:  I think radiotherapy is so well recognized in Amsterdam, and getting Dutch radiotherapy is so well recognized around the world.

David Morgan:  Serendipity is a question of being in the right place at the right time.

Harry Bartelink:  Right. 

David Morgan:  But it has to be the right man as well, Harry.  It has to be the right man at the right place at the right time.

Harry Bartelink:  Yeah.

David Morgan:  What do you see for the future of radiotherapy, Harry?  What current trends do you think are going to be expanding?  What things that we're doing do you think are going to fade away?  If that's not too broad a question.  Are we going to become -- is everything going to be hypofractionated small volumes?

Harry Bartelink:  I think that the future will be that we will move forward with precision medicine.  This means that we will use much better imaging modalities.  We will use much better predicted essays and assessment of tumor response.  We are working on it not only for breast cancer but also we have a trial on head and neck and lung cancer where we have the biopsies before and after treatment.  I assume that, based upon that, we know much better the tumor characteristics.  Also, we will learn which target we should attack.  Whether it's immune response or whether there's a different possibility, that will be in the future.  There will be much more individualized treatment, much more precise, and much better rationale combinations with selected drugs - whatever it will be - in combination with radiotherapy.  Yeah.  Did that answer your question?

David Morgan:  I think that's a very nice answer.  Thank you very much.

Ismail Kazem:  Related to this, there are actually three contributions to radiation oncology.  One is physics.  With physics, I add also technology.  And in technology, also the future artificial intelligence.  In the middle is the clinical judgment and the bedside input.  And the third is radiobiology.  Of the three, which is the most important in the future?  Did we exhaust all the radiobiology in the world and have to replace that with the immune and the genetic aspect of the tumor, and graded accordingly and characterize it, and set off morphology on gene markers?  I would like to hear your thoughts.

Harry Bartelink:  Let's say I think it's a pity that the young generation has no interest and has no knowledge of radiobiology.  It's a shame.  That's to say we don't train young radiation oncologists anymore in that field.  There's still a lot to learn; hence, that's a pity.  But we cannot avoid new developments.  You mentioned already artificial intelligence.  That certainly helps us in selecting patients in the future. 

With that said, the immunomodulation that we talked about, that will also help us.  But still if you want to do good experiments for immunomodulation, then you need to have a basic background also in radiobiology.  It is important understand the limitations of your experiments. 

David Morgan:  If you don't understand radiobiology, you can't get a handle for how the changes that you're making will pan out.  Quite right.  I think that's what you're saying, is it?

Harry Bartelink:  Right,

Ismail Kazem:  And you are lucky in that, in Holland, you have in Rijswijk the institute of radiobiology.  So you have a concentrated institute.  No?

Harry Bartelink:  No, You were right, the Rijkswijk institute was a wonderful laboratory with for example Eddie Barendsen for radiobiology.  But the problem was, and that's I've seen with many radiobiologists, they didn't make the switch to modern molecular biology.  They became too traditional.  You see, they were not capable to make that link to the modern possibilities that molecular biology offers to us.  That's a shame.  Therefore, the whole institute in Rijkswijk disappeared.

Ismail Kazem:  That's a shame.

Harry Bartelink: It seems difficult worldwide for radiation biology to make the switch to modern molecular biology because they are in competition with very bright young molecular biologists that do fancy research. 

Ismail Kazem:  Could you tell us some stories about some of the figures you have contemporary or before you? Like Breur, Messing, Maurice Tubiana Give us some anecdotal reminiscence about your encounter with those people who were in avant-garde.

Harry Bartelink:  Maybe first, one thing before I forget, I would like to mention two other names that I worked closely with.  First is Manu Van Der Schueren.

Ismail Kazem:  Oh, Emmanuel.  Yes, yes.

Harry Bartelink:  I would like to mention that.

Ismail Kazem:  May he rest in peace.  Yes.

Harry Bartelink:  Because during my training in Amsterdam, he also worked in Amsterdam with Klaas Breur.  I met him and we became good friends.  We stayed that for the whole period, until he unfortunately died.  I had a lot of fun, but also a lot of interaction with him.  The other person in Europe that I had a lot of fun with and worked with is Jens Overgaard. Both we became good friends.

Ismail Kazem:  What about Peckham?

Harry Bartelink:  Peckham I met a couple of times, but that was much more on a distance.

David Morgan:  Mentioning Van Der Schueren  reminds me, Harry, you touched on the subject of quality assurance and its importance.

Harry Bartelink:  Yeah.

David Morgan:  But you didn't elaborate.  I'd love to hear your recollections about the quality assurance program and its importance.

Harry Bartelink:  I explained to you I became interested in seeing the difference and outcome of treatments in breast cancer per institute.  Let’s say for a large variation, between 4 percent and 35 percent local failure rate. 

David Morgan:  That’s conservation.

Harry Bartelink:  Yes, the breast conversation trial.  With Jean-Claude Horiot and Manu Van Der Schueren, we looked at the head and neck cancer trials for example and visited the participating institutes    I remember that with  Jean-Claude Horiot, we looked at a patient records and images, it was obvious only half of the tumor was covered by the treatment portals, nevertheless that cancer patient survived.  Jean-Claude and I couldn't understand how was it possible that patient had been cured. 

If I go back to the breast cancer trials I was responsible for: the local recurrence rate in these trials dropped significantly I think mainly because of the quality assurance and/or strict protocols.
David Morgan:  Peer review was what the meetings were called.  That's a widely quoted term these days.  But I think the EORTC radiotherapy group was the real pioneer in that process, wasn't it?  The rest of the world is still catching up, I think, with the way it was done.

Harry Bartelink:  Right.  Correct.  Yeah.  We were just the first and we spent a lot of time in the participating institutes.  It was not only quality assurance, but it was a lot of education of the local PIs.  So it was much more an education process, I would say, than the quality assurance per se.

David Morgan:  But it was also interactive.

Harry Bartelink:  Yeah.

David Morgan:  Very much.  It wasn't someone going with a tick box and checking what was being done.  It was an interactive process and I think people welcomed it.  I mean I remember I have had the peer review visits.  We always welcomed the comments and feedback.  It really was way ahead of its time.

Harry Bartelink:  And certainly, it's for both sides.  For us, let's say we learned a lot.

David Morgan:  That’s the point.  That's the point, yeah.

Ismail Kazem:  Harry, you supervised 53 candidates' research for the degree of PhD.  You supervised their thesis.  How did you manage to find the time between your clinical obligation, your lectures, your publications and your research?  How did you balance all this intensive activity?

Harry Bartelink:   I had a wonderful team in my department, with very interesting people.  It's not only my work, that was teamwork,  Adrian Begg Marcel van Herk and Ben Mijnheer that led to these PhD  publications.

Ismail Kazem:  That is very important to delegate and have a good and efficient team to support you.

Harry Bartelink:  Yeah.

Ismail Kazem:  What hobbies do you have?

Harry Bartelink:  I like ice skating in winter I go skating each week on an artificial ice rink with my daughter.  But the problem is that in the beginning I was faster.  In the beginning I was faster than my grandchildren.

David Morgan:  Now they're faster than you.

Harry Bartelink:  Indeed my grandchildren are better than I am.  That's painful.  Okay.

David Morgan:  Did you ever get that boat, Harry?

Harry Bartelink:  Yes, I have the boat.

David Morgan:  Yeah, I thought so.

Harry Bartelink:  To be honest, we lived there 15 years.  I thought after my work in summer I would sail.  I did it only three times in 15 years after my work.  It was only three times because three people from my department went through a divorce period.  I thought let them come to my house, let them sail, let me talk to them because it will have an impact on their work too.  So it was still work related then, you can see.  I tried to calm down my people through that.

David Morgan:  You're not sailing now?

Harry Bartelink:  Oh, yes.  Yes, after my retirement.  Yes.  I have the sailing boat. 

David Morgan:  That’s good.

Harry Bartelink:  But I do much more nowadays.  After my retirement, I learned rowing.  So I row in the skiff three times a week early in the morning with friends.  You'll see me in summer at 7:00.  In winter, it's 9:00.  I row a boat at home but also I do it in a club with other people.  That's been fascinating.  Yeah, I like that.  And I can row here from my house to the lakes here in the surrounding.  It's wonderful.  It's early in the morning, nobody on the water.  I have the whole area for my own. 

David Morgan:  You can go anywhere in the Netherlands if you've got a rowing boat I imagine.

Harry Bartelink:  Yeah.  But the problem is it's a skiff.  You know, the skiffs are the small boats.

David Morgan:  Oh, yeah.

Harry Bartelink:  In the beginning it was very hard to learn.  Sometimes I went over the top and fall off the boat.  It was difficult to climb in.

Ismail Kazem:  An hour had passed.  Could you believe that?  That's nice chat and nice interview.  One last question.  Did you get your vaccine against COVID?

Harry Bartelink:  No.  No.  I'm afraid I still have to wait two months.

Ismail Kazem:  Oh.  It's not yet available?

Harry Bartelink:  Not yet.  There's just not enough.  The European Union not get sufficient supply, at present there's not enough to vaccinate all the people in Holland, so it will take some time.

Ismail Kazem:  It has been a pleasure to chat with you guys.  The start of the discussion has given us a glimpse of his very rich career.  I think we need a full week to really get the full story of his achievements but, anyway, we had a good exposure of it.

Harry Bartelink:  But let me thank you.    Together now,during lockdown, talking to you both was very pleasant.  Ismail Kazem:  Thank you much.  Thank you, David.

David Morgan:  Lovely to talk to you, Ismail.  Lovely to talk and see you, Harry.